The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations.
To describe the ...incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART.
Cohort study.
HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020.
77 590 HIV-positive persons receiving ART.
Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction-confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models.
Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died.
Residual confounding by comorbid conditions cannot be completely excluded.
HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV.
Instituto de Salud Carlos III and National Institutes of Health.
Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP ...programmes within its heterogeneous health system.
Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study.
A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals' perceptions of PrEP feasibility were positive, except for the lack of personnel.
PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess the awareness, knowledge, use, and willingness to use and need of PrEP among men who have sex with men (MSM) and transgender women (TW) who attended World Gay Pride (WGP) 2017 in Madrid.
...Online survey. Participants were recruited through gay-oriented dating apps and HIV Non-Governmental Organizations´ social media. Inclusion criteria included being MSM or TW, age 18 years old or above, and having attended WGP in Madrid. Information regarding the participant's awareness and knowledge, use or willingness to use, and need for PrEP was collected, as well as sociodemographic characteristics. Participants were considered to be in need of PrEP if they met one of the following indication criteria: having practiced unprotected anal intercourse with more than 2 partners, having practiced chemsex, or having engaged in commercial sex-all in the preceding 6 months. Descriptive and multivariable analyses with logistic regression were conducted.
472 participants met the inclusion criteria and completed the questionnaire. The mean age was 38, 97.7% were MSM, 77% had a university education, and 85% were living in Spain, mostly in big cities. Overall, 64% of participants were aware of PrEP, but only 33% knew correctly what PrEP was. 67% of HIV-negative participants were willing to take PrEP, although only 5% were taking it during WGP, mostly due to lack of access. 43% of HIV-negative respondents met at least one PrEP indication criteria. For HIV-negative men living in Spain, university education and living in big cities was associated with PrEP awareness. Lower education level and meeting PrEP criteria was associated with willingness to use PrEP.
Our study shows that among MSM attending WGP 2017 in Madrid, there was limited PrEP awareness, low accuracy of PrEP knowledge, and a high need and willingness to use PrEP. Health authorities should strengthen existing preventive strategies and implement PrEP.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
HER2‐positive gastric cancer (GC) affects 7%–34% of patients with GC. Trastuzumab‐based first‐line treatment has become the standard of care for HER2‐positive advanced gastric cancer ...(AGC). However, there are no clinically validated biomarkers for resistance to HER2‐targeted therapies. Upregulation of PI3K pathway and tyrosine kinase receptor (TKR) alterations have been noted as molecular mechanisms of resistance in breast cancer. Our study aimed to perform a molecular characterization of HER2‐positive AGC and investigate the role of PI3K/Akt/mTOR signaling pathway activation and TKR gene copy number (GCN) gains as predictive biomarkers in HER2‐positive AGC treated with trastuzumab.
Patients and Methods
Forty‐two HER2‐positive GC samples from patients treated with trastuzumab‐based first‐line chemotherapy were selected. DNA samples were sequenced. PTEN and MET immunohistochemistry were also performed.
Results
Concurrent genetic alterations were detected in 97.1% of HER2‐positive AGC. We found activation of PI3K/Akt/mTOR pathway in 52.4% of patients and TKR GCN gains in 38.1%. TKR GCN gains did not correlate with overall survival (OS) or progression‐free survival (PFS). Multivariate Cox models showed that PI3K/Akt/mTOR activation negatively affects the effectiveness of trastuzumab‐based chemotherapy in terms of OS and PFS.
Conclusion
Our results provide for the first time a detailed molecular profile of concurrent genetic alterations in HER2‐positive AGC. PI3K pathway activation could be used as a predictive marker of worse outcome in this patient population. In addition, gains in copy number of other TKR genes in this subgroup may also influence the survival benefit obtained with trastuzumab.
Implications for Practice
This article reports, for the first time, a detailed molecular profile of genomic alterations in patients with HER2‐positive advanced gastric cancer (AGC). PI3K/Akt/mTOR signaling pathway activation seems to have a differentially negative effect on overall survival and progression‐free survival in AGC treated with trastuzumab‐based chemotherapy. Combining different targeted agents could be a successful therapeutic strategy to improve the prognosis of HER2‐positive AGC.
摘要
背景。HER2阳性胃癌(GC)占所有胃癌的7%‐34% 。基于曲妥珠单抗的一线疗法已经成为HER2阳性晚期胃癌 (AGC)的标准治疗方法。然而,关于HER2靶向治疗耐药性,尚无经过临床验证的生物标志物。上调PI3K信号通路和酪氨酸激酶受体(TKR)改变已经被视为乳腺癌耐药性的分子机制。我们的研究旨在揭示HER2阳性AGC的分子特征,探索PI3K/Akt/mTOR信号通路激活和TKR基因拷贝数(GCN)增加作为预测性生物标志物在曲妥珠单抗经治HER2阳性AGC患者中的作用。
患者和方法。从接受基于曲妥珠单抗一线化疗方案治疗的患者中选取42份HER2阳性胃癌样本。DNA样本测序。实施PTEN和MET免疫组化。
结果。在97.1%的HER2阳性AGC样本中检测出并发的基因改变。我们在52.4%的患者中发现PI3K/Akt/mTOR信号通路激活,在38.1%的患者中发现TKR GCN增加。TKR GCN增加与总生存期(OS)或无进展生存期(PFS)无关。多变量Cox模型显示,PI3K/Akt/mTOR激活对基于曲妥珠单抗化疗的有效性(在OS和PFS方面)产生不利影响。
结论。我们的结果首次提供了HER2阳性AGC并发基因改变的详细分子谱。PI3K信号通路激活可作为此类患者人群预后不良的预测性标志物。此外,此类亚组人群中其它TKR基因拷贝数的增加也可能影响曲妥珠单抗治疗的生存益处。
实践意义:本文首次报告了HER2阳性晚期胃癌(AGC)患者基因改变的详细分子谱。PI3K/Akt/mTOR信号通路激活看起来对接受基于曲妥珠单抗化疗方案治疗的AGC患者的总生存期和无进展生存期产生了不同的不利作用。不同靶向药物的联合应用可能是改善HER2阳性AGC预后的成功治疗策略。
This article describes genomic profiling of patients with HER2‐positive advanced gastric cancer who were treated with first‐line trastuzumab‐based chemotherapy, focusing on whether PI3K/Akt/mTOR pathway status could be relevant in selecting suitable patients for targeted therapies.
The incidence of stroke in human immunodeficiency virus (HIV)-infected individuals has been well analyzed in recent epidemiological studies. However, little is known about the specific contribution ...of hepatitis C virus (HCV) infection to stroke among HIV-infected individuals. The aims of this study were to analyze trends in the incidence rates of stroke in HIV-infected individuals during the combination antiretroviral (cART) era in Spain and to categorize them by the presence or absence of HCV coinfection. We analyzed hospital discharges with a diagnosis of stroke in Spain according to ICD-9-CM during 1997-2013. The study period was divided into four calendar periods (1997-1999, 2000-2003, 2004-2007, and 2008-2013). Patients were classified according to HCV serology. The number of HIV-infected patients was estimated based on data from the National Centre of Epidemiology. We calculated incidence rates (events per 10,000 patient-years) and in-hospital case fatality rates (CFR). The incidence of hemorrhagic stroke (HS) decreased in HIV-monoinfected patients (15.8 1997-1999 to 6.5 2008-2013; P<0.001) and increased in HIV/HCV-coinfected patients (1.3 1997-1999 to 5.5 2008-2013; P<0.001). The incidence of ischemic stroke (IS) decreased in HIV-monoinfected patients (27.4 1997-1999 to 21.7 2008-2013; P = 0.005) and increased in HIV/HCV-coinfected patients (1.8 1997-1999 to 11.9 2008-2013; P<0.001). The CFR was 3.3 times higher for HS than for IS for the whole study period. The CFR of HS in HIV-monoinfected patients decreased significantly (47.4% 1997-1999 to 30.6% 2008-2013; P = 0.010) but did not change significantly among HIV/HCV-coinfected patients (41.4% 1997-1999 to 44.7% 2008-2013; P = 0.784). The CFR of IS in the whole HIV-infected population decreased significantly (14.6% 1997-1999 to 10.9% 2008-2013; P = 0.034), although no significant differences were found when each group was analyzed separately. In conclusion, after the introduction of cART, HS and IS rates decreased in HIV-monoinfected individuals, but increased steadily in HIV/HCV-coinfected individuals.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A retrospective look at the architecture competitions held and reported in Spain between the years of transition to democracy and the aftermath of the global financial crisis of 2008 allows us to ...verify, from a sociological and historiographical approach, the progressive inclusion of women into the complex and traditionally patriarchal cultural field of the architecture competition. The end of Franco’s dictatorship, and the growing vitality of the Autonomous Regions prompted the call of numerous open consultations throughout the country. These calls continued throughout the last third of the 20th century, until eventually experiencing a decline in the new millennium. These open and anonymous competitions provided a framework in which many women architects were able to ascend through merit, even attaining important positions within the process: firstly, as recognised participants and later as jury members. Highlighting the value of these women’s contribution to architecture has always been subject to disinterest, hesitancy or even outspoken reticence, typical of an eminently patriarchal structure, to which were added those inherent to any competitive structure where the struggle for the domination of symbolic power is inescapable. On the basis of architectural journal articles and illustrative case studies, this paper reviews the published media conditions of this difficult ascent in which the subordinate territories peripheral to the centres of production of architectural culture—Madrid and Barcelona—proved to be a space of opportunity and competition in which to build professional legitimacy. A great deal of Spanish women architects who were regular contestants achieved their recognition through silent logic, far removed from flashy celebrity, an issue that has left a deep imprint on their ways of approaching the practice of their profession, in general, and of participating in the cultural field of the competition, in particular. From this common thinking, this article aims to pay them a well-deserved tribute.
Durante los últimos 50 años se han producido cambios significativos en las cubiertas y usos del suelo, principalmente aquellos catalogados como artificiales. Este proceso, y su generalización a ...escala global, afectan de forma directa a las funciones básicas del suelo, acrecentando otros problemas como pueden ser la pérdida de biodiversidad, contaminación, degradación edáfica, inundaciones, o los efectos del cambio climático. En el área de estudio (Mazarrón, Región de Murcia) el problema anterior resulta ejemplar: el binomio desarrollo urbano asociado al turismo de sol y playa y la agricultura intensiva (bajo invernaderos) alteran de forma drástica la naturaleza del suelo. El objetivo es establecer un modelo de clasificación supervisada que distinga, con un error asumible, las distintas clases establecidas, destacando sobre todas ellas las que supongan superficies sellantes y, además, realizar una comparación con la información del último Corine Land Cover disponible (2018). Para ello, se seleccionaron imágenes del satélite Sentinel 2A y se ejecutó una clasificación de máxima verosimilitud. Para validar los resultados, se elaboró una matriz de confusión en la que se obtuvo una precisión general del 89 %. Finalmente, se observó una subestimación significativa, por parte del Corine Land Cover, del 75 % de las superficies selladas debido a su resolución.
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